Our expert answers common questions about bipolar disorder and the latest research shaping its care and treatment.
Bipolar disorder is a complex mental health condition that affects mood, energy and daily life for up to 3.4 per cent of Canadians. While misconceptions about the disorder persist, research has expanded our understanding of its underlying biology, long-term outcomes and the factors that influence how it is experienced and treated.
Vancouver Coastal Health Research Institute researcher Dr. Ivan Torres discusses how scientific understanding of bipolar disorder has evolved and how research is informing more personalized approaches to care and long-term management.
Q: What is bipolar disorder, and how does it affect a person’s mood, thinking and daily life?
A: Bipolar disorder (BD) is a major psychiatric mood disorder characterized by fluctuating mood episodes involving either mania or hypomania. Mania involves an extremely elevated or irritable mood and high energy lasting at least one week, while hypomania is a less severe change in mood and energy that lasts at least four days.
In addition to manic or hypomanic episodes, most people with BD experience depressive episodes involving intense low mood and loss of interest or pleasure in daily activities.
Q: What is the difference between bipolar I and bipolar II, and why does that distinction matter for care?
A: A person who experiences at least one confirmed manic episode is diagnosed with bipolar I disorder, regardless of whether they experience depression. A person who experiences at least one hypomanic episode and one depressive episode — but no manic episodes — is diagnosed with bipolar II disorder.
Although there is overlap between the two subtypes, distinguishing between them is important because it helps guide the most appropriate treatment approach.
Q: How has our understanding of bipolar disorder evolved, particularly in terms of long-term outcomes and progression?
A: Research shows that long-term outcomes vary significantly among people living with BD. Early identification and diagnosis remain major challenges, which is a critical issue, as timely and appropriate treatment are key to improving the likelihood of positive outcomes.
While the question of whether BD is a progressive illness that worsens over time has yet to be answered, evidence clearly shows that appropriate treatment can help stabilize symptoms and reduce the risk of symptoms worsening.
Q: What does current research tell us about the biological and genetic factors involved in bipolar disorder?
A: Research has identified structural and functional brain changes in emotional and cognitive brain circuits among people with BD compared to people without the disorder, but there is currently no single biomarker that can definitively diagnose the illness.
Genetic findings are similarly complex. BD has a strong genetic basis and is more common among people with a family history of the disorder. However, researchers believe this is likely due to the combined effects of many genes rather than the impact of any single gene.
Q: How is research shaping more personalized and effective treatment approaches for people living with bipolar disorder?
A: As researchers learn more about the biological mechanisms underlying BD, there is growing interest in identifying biomarkers that can be measured reliably and objectively. These may include indices of brain function derived from brain scans, blood tests, genetic tests or other related biological measures.
In the future, these advances could allow clinicians to better predict prognosis and tailor treatments to an individual’s specific needs.
Q: What evidence-based strategies can help people manage bipolar disorder day-to-day and support overall well-being?
A: In addition to psychotherapy and medication-based treatment, a range of evidence-based self-management strategies can help support health and well-being for people living with BD.
An excellent resource is CREST.BD, which provides science-backed information and practical resources on topics relevant to people living with BD. The platform includes blogs, videos, online tools and apps designed for people living with BD, their families, clinicians and the broader BD community.
